2008-09 First-year Application

For Spring 2009, Fall 2009, or Spring 2010 Enrollment

PERSONAL DATA
p Female
Legal name __________________________________________________________________________________________________________________
p Male
Last/Family (Enter name exactly as it appears on official documents.) First/Given Middle (complete) Jr., etc.

Preferred name, if not first name (choose only one)_______________________ Former last name(s), if any _______________________________________
Birth date_ ____________________________________________________
mm/dd/yyyy
Citizenship
p US citizen How many years have you lived in the United States? _____________________
p Dual US citizen List any non-US countries of citizenship ______________________________
p US permanent resident visa (Alien registration # ______________________) ______________________________
p Other citizenship (Visa type ______________________________________) ______________________________

Optional The following items are optional. No information you provide will be used in a discriminatory manner.
Place of birth _____________________________________________________ If you wish to be identified with a particular ethnic group, please check all that apply:
City/Town State/Province Country p African American, African, Black
Social Security Number (if any) ___________________
______________________ p Native American, Alaska Native (date enrolled ___________________________
Tribal affiliation _________________________________________________)
First language, if other than English _____________________________________
p Asian American (country _________________________________________)
Primary language spoken at home, if other than English _____________________ p Asian, incl. Indian Subcontinent (country ______________________________)
US Armed Services veteran? p Yes p No p Hispanic, Latino (country __________________________________________)
Marital status: p Never married p Mexican American, Chicano
p Married p Puerto Rican
p Widowed p Native Hawaiian, Pacific Islander
p Separated p White or Caucasian
p Divorced (date ________________________)
mm/yyyy p Other (specify ________________________________________ _____________)

ADDRESS
E-mail address _________________________________________________ IM address ____________________________________________________
Permanent home address __________________________________________________________________________________________________________
Number & Street Apartment #
____________________________________________________________________________________________________________________________
City/Town State/Province Country ZIP/Postal Code
Permanent home phone (_____________) _____________________________ Cell phone (_____________) ______________________________________
Area Code Area Code
If different from above, please give your current mailing address for all admission correspondence.
Current mailing address __________________________________________________________________________________________________________
Number & Street Apartment #
____________________________________________________________________________________________________________________________
City/Town State/Province Country ZIP/Postal Code
If your current mailing address is a boarding school, include name of school here: ____________________________________________________________
_____
Phone at current mailing address (_____________) _____________________ (from ___________ to ___________)
Area Code (mm/dd/yyyy) (mm/dd/yyyy)

FUTURE PLANS
Your answers to these questions will vary for different colleges, and not all colleges require a response to each. Please complete the rest of page 1 and make
photocopies of the page. Then complete this Future Plans section as appropriate for each of the colleges to which you are applying.  It is important that students review
institutional publications or websites for complete application requirements and instructions.  If applying Early Decision please submit the Common Application ED
Agreement if the college or university requires one.
College ___________________________________________________________________________ Deadline ___________________________________
mm/dd/yyyy
Entry Term: p Fall (Jul-Dec) p Spring (Jan-Jun) Do you intend to apply for need-based financial aid? p Yes p No
Do you intend to apply for merit-based scholarships? p Yes p No
Decision Plan: p Regular Decision p Rolling Admission
p Early Decision I p Early Decision II Do you intend to live in college housing? p Yes p No
p Early Action I p Early Action II Do you intend to be a full-time student? p Yes p No
p Restrictive Early Action p Early Admission
juniors only
Do you intend to earn a degree? p Yes p No
Possible area(s) of academic concentration/major(s) __________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Possible career or professional plans______________________________________________________________________________________________
© 2008 The Common Application, Inc. AP-1 / 2008-09
 FAMILY
Please list both parents below, even if one or more is deceased or no longer has legal responsibilities toward you. Many colleges collect this information for demo-
graphic purposes even if you are an adult or an emancipated minor. If you are a minor with a legal guardian (an individual or government entity), then please list that
information below as well. If you wish, you may list step-parents and/or other adults with whom you reside, or who otherwise care for you, in the Additional Information
section or on an attached sheet.

Household
Parents’ Marital Status (relative to each other): p Never married p Married p Widowed p Separated p Divorced (date ________________________)
mm/yyyy
With whom do you make your permanent home? p Parent 1 p Parent 2 p Both p Legal Guardian p Ward of the Court/State p Other
Parent 1: p Mother p Father p Unknown Parent 2: p Mother p Father p Unknown
Is Parent 1 living? p Yes p No (Date deceased ____________________) Is Parent 2 living? p Yes p No (Date deceased ____________________)
mm/yyyy mm/yyyy

____________________________________________________________ ____________________________________________________________
Last/Family First/Given Middle Title (Mr./Ms./Dr., etc.) Last/Family First/Given Middle Title (Mr./Ms./Dr., etc.)

Country of birth ________________________________________________ Country of birth ________________________________________________

Home address if different from yours Home address if different from yours

____________________________________________________________ ____________________________________________________________

____________________________________________________________ ____________________________________________________________

Home phone (_______) __________________________________________ Home phone (_______) __________________________________________

Area Code Area Code

E-mail _______________________________________________________ E-mail _______________________________________________________

Occupation _____________________________________________________ Occupation _____________________________________________________

Name of employer ______________________________________________ Name of employer ______________________________________________

College (if any) _________________________________________________ College (if any) _________________________________________________

Degree _________________________________________ Year _________ Degree _________________________________________ Year _________

Graduate school (if any) __________________________________________ Graduate school (if any) __________________________________________

Degree _________________________________________ Year _________ Degree _________________________________________ Year _________

Legal Guardian (if other than a parent) Siblings

Please give names and ages of your brothers or sisters. If they have attended or
Relationship to you _______________________________________________ are currently attending college, give the names of the undergraduate institution,
degree earned, and approximate dates of attendance. If more than three siblings,
____________________________________________________________ please list them in the Additional Information section or on an attached sheet.
Last/Family First/Given Middle Title (Mr./Ms./Dr., etc.)

Home address if different from yours ____________________________________________________________

Name Age Relationship
____________________________________________________________ College Attended________________________________________________
____________________________________________________________
Degree Earned _________________________ Dates_ __________________
or Expected yyyy-yyyy
Home phone (_______) __________________________________________
Area Code
____________________________________________________________
E-mail _______________________________________________________ Name Age Relationship

College Attended________________________________________________
Occupation _____________________________________________________

Name of employer ______________________________________________ Degree Earned _________________________ Dates_ __________________

or Expected yyyy-yyyy

College (if any) _________________________________________________

____________________________________________________________
Name Age Relationship
Degree _________________________________________ Year _________
College Attended________________________________________________
Graduate school (if any) __________________________________________
Degree Earned _________________________ Dates_ __________________
Degree _________________________________________ Year _________ or Expected yyyy-yyyy

AP-2 / 2008-09 © 2008 The Common Application, Inc.

 AC ADEMICS
Secondary Schools
Current or most recent secondary school attended_ ______________________________________________________________________________________
Entry Date __________________ Graduation Date __________________ School Type p public p charter p independent p religious p home school
mm/yyyy mm/dd/yyyy

Address ________________________________________________________________________________ CEEB/ACT Code ___________________________

Number & Street

__________________________________________________________________________________________________________________________________
City/Town State/Province Country ZIP/Postal Code

Counselor’s name (Mr./Ms./Dr., etc.) ____________________________________________ Counselor’s Title ______________________________________

E-mail _____________________________________ Phone (_______) ______________________ Fax (_______) _________________________________

Area Code Number Ext. Area Code Number

List all other secondary schools, including summer schools as well as summer and other programs, you have attended, beginning with 9th grade.
School Name & CEEB/ACT Code Location (City, State/Province, ZIP/Postal Code, Country) Dates Attended (mm/yyyy)
_____________________________________________ _______________________________________________________ ____________________
_____________________________________________ _______________________________________________________ ____________________
_____________________________________________ _______________________________________________________ ____________________

If your secondary school education was or will be interrupted, check all that apply and provide details in the Additional Information section or on an attached sheet.
p did/will graduate late p did/will change secondary schools p did not/will not graduate
p did/will graduate early p did/will take time off p did/will receive GED Date: _______________ (Official scores must be sent from the testing agency.)
mm/yyyy

Colleges & Universities List all colleges/universities at which you have taken courses for credit; list names of courses taken and grades earned on a separate
sheet. Please have an official transcript sent from each institution as soon as possible.
College/University Name & CEEB/ACT Code Location (City, State/Province, ZIP/Postal Code, Country) Degree Candidate? Dates Attended Degree(s) Earned
Yes No (mm/yyyy)
_________________________________ ___________________________________________ p p __________________ __________________

_________________________________ ___________________________________________ p p __________________ __________________

_________________________________ ___________________________________________ p p __________________ __________________

Standardized Tests
Be sure to note the tests required for each institution to which you are applying. The official scores from the appropriate testing agency must be submitted to each
institution as soon as possible. Please self-report your test scores below.

ACT Tests Date taken/ English Math Reading Science Composite Writing Date taken/ English Math Reading Science Composite Writing
to be taken to be taken

SAT Reasoning Tests

Date taken/ Critical Math Writing Date taken/ Critical Math Writing Date taken/ Critical Math Writing
to be taken Reading to be taken Reading to be taken Reading

SAT Subject Tests

Date taken/ Subject Score Date taken/ Subject Score Date taken/ Subject Score
to be taken to be taken to be taken

Date taken/ Subject Score Date taken/ Subject Score Date taken/ Subject Score
to be taken to be taken to be taken

AP/IB Tests Date taken/ Subject Score Date taken/ Subject Score Date taken/ Subject Score
to be taken to be taken to be taken

Date taken/ Subject Score Date taken/ Subject Score Date taken/ Subject Score
to be taken to be taken to be taken

Date taken/ Subject Score Date taken/ Subject Score Date taken/ Subject Score
to be taken to be taken to be taken

TOEFL/IELTS/MELAB Date taken/ Test Score Date taken/ Test Score Date taken/ Test Score
to be taken to be taken to be taken
AP-3 / 2008-09 © 2008 The Common Application, Inc.
Honors Briefly list any academic distinctions or honors you have received since the 9 th grade or international equivalent (e.g. National Merit, Cum Laude Society).
Grade level or Honor Level of Recognition
post-graduate (PG)
School State/ National Inter-
9 10 11 12 PG Regional national

p p p p p _________________________________________________________________________________ p p p p
p p p p p _________________________________________________________________________________ p p p p
p p p p p _________________________________________________________________________________ p p p p
p p p p p _________________________________________________________________________________ p p p p
p p p p p _________________________________________________________________________________ p p p p

ACTIVITIES
Extracurricular Please list your principal extracurricular, community, volunteer and family activities and hobbies in the order of their interest to you. Include
specific events and/or major accomplishments such as musical instrument played, varsity letters earned, etc. To allow us to focus on the highlights of your
activities, please complete this section even if you plan to attach a résumé.

Grade level or Approximate When did you participate If applicable,

post-graduate (PG) time spent in the activity? do you plan
Positions held, honors won, or letters earned
Hours Weeks School Summer to participate
9 10 11 12 PG per week per year year in college?

p p p p p p p ________________________________________________________________ p
Activity_ _________________________________________________________________________________________________________________

p p p p p p p ________________________________________________________________ p
Activity_ _________________________________________________________________________________________________________________

p p p p p p p ________________________________________________________________ p
Activity_ _________________________________________________________________________________________________________________

p p p p p p p ________________________________________________________________ p
Activity_ _________________________________________________________________________________________________________________

p p p p p p p ________________________________________________________________ p
Activity_ _______________________________________________________________________________________________________________

p p p p p p p ________________________________________________________________ p
Activity_ _________________________________________________________________________________________________________________

p p p p p p p ________________________________________________________________ p
Activity_ _________________________________________________________________________________________________________________

Work Experience Please list paid jobs you have held during the past three years (including summer employment).
School Summer Approximate dates Hours
Specific nature of work Employer year (mm/yyyy - mm/yyyy) per week

___________________________________________ ___________________________________ p p _______________ ______

___________________________________________ ___________________________________ p p _______________ ______

___________________________________________ ___________________________________ p p _______________ ______

___________________________________________ ___________________________________ p p _______________ ______

AP-4 / 2008-09 © 2008 The Common Application, Inc.

 WRITING
Short Answer Please briefly elaborate on one of your extracurricular activities or work experiences in the space below or on an attached sheet (150 words or fewer).

____________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________

Personal Essay Please write an essay (250 words minimum) on a topic of your choice or on one of the options listed below. Please indicate your topic by
checking the appropriate box. This personal essay helps us become acquainted with you as a person and student, apart from courses, grades, test scores, and
other objective data. It will also demonstrate your ability to organize your thoughts and express yourself.

p 1 Evaluate a significant experience, achievement, risk you have taken, or ethical dilemma you have faced and its impact on you.
p 2 Discuss some issue of personal, local, national, or international concern and its importance to you.
p 3 Indicate a person who has had a significant influence on you, and describe that influence.
p 4 Describe a character in fiction, a historical figure, or a creative work (as in art, music, science, etc.) that has had an influence on you, and explain that influence.
p 5 A range of academic interests, personal perspectives, and life experiences adds much to the educational mix. Given your personal background, describe an
experience that illustrates what you would bring to the diversity in a college community, or an encounter that demonstrated the importance of diversity to you.
p 6 Topic of your choice.
Attach your essay to the last page on a separate sheet(s) (same size please). You must put your full name, date of birth, and name of secondary school on each sheet.

Disciplinary History
a Have you ever been found responsible for a disciplinary violation at an educational institution you have attended from 9th grade (or the international equivalent)
forward, whether related to academic misconduct or behavioral misconduct, that resulted in your probation, suspension, removal, dismissal, or expulsion from
the institution? p Yes p No
b Have you ever been convicted of a misdemeanor, felony, or other crime? p Yes p No
If you answered yes to either or both questions, please attach a separate sheet of paper that gives the approximate date of each incident and explains the circumstances.

Additional Information If there is any additional information you’d like to provide regarding special circumstances, additional qualifications, etc., please do so in the
space below or on an attached sheet.

____________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________

SIGNATURE & PAYMENT

Application Fee Payment p Online Payment p Mailed Payment p Online Fee Waiver Request p Mailed Fee Waiver Request
Required Signature
I certify that all information submitted in the admission process—including the application, the personal essay, any supplements, and any other supporting materials—
is my own work, factually true, and honestly presented. I understand that I may be subject to a range of possible disciplinary actions, including admission revocation or
expulsion, should the information I’ve certified be false. In addition, I authorize the release of my admission decision to my secondary school.

Signature _______________________________________________________________________________________________ Date ___________________

mm/dd/yyyy

The Common Application, Inc., and its member institutions are committed to fulfilling their mission without discrimination on the basis of race, color,
national origin, religion, age, sex, gender, sexual orientation, disability, or veteran status.

AP-5 / 2008-09 © 2008 The Common Application, Inc.